#StateOfEnrollment: Coordination Key in North Carolina

By Molly Warren

Strategy: Coordinating logistics among stakeholders to maximize their application assistance efforts.

Where and when it was used: North Carolina

Notable metrics:

Best practices to replicate:

  • Coordinate state-wide coalition that includes a variety of stakeholders
  • Build on existing, successful health coverage enrollment efforts
  • Create one statewide phone line consumers can call to schedule appointments with in-person assisters

North Carolina’s enrollment numbers are remarkably high. More than 200,000 North Carolinians enrolled in marketplace plans between October 1, 2013 and March 1, 2014. This is proportionally more potential consumers in marketplace plans than almost any other federally facilitated marketplace. The state has also done well enrolling North Carolinians eligible for Medicaid and the Children’s Health Insurance Program (CHIP). During open enrollment, North Carolina’s Medicaid program grew by 44,000 enrollees (2.4 percent).

When looking into some of the reasons behind North Carolina’s success, their strong coordination among stakeholders pops to the forefront. At the beginning of 2013, long time partners on other health issues formed a coalition, called the “Big Tent”, which focused on the new health coverage options made available under the Affordable Care Act. From within these coalitions, eleven non-profit organizations created the “Navigator Consortium”; together they applied for and received one of the largest navigator grants in the country. The Consortium provides enrollment assistance through much of the state’s 100 counties with a remarkable level of coordination. Perhaps it is not surprising when you look at what they brought to the table:

  • Variety of stakeholders: The Big Tent includes a broad array of stakeholders, including various providers (from individual physicians to health centers and hospitals), state and local health department and social service agencies, and community-based and consumer organizations.
  • Experience with enrollment: The coalition members brought prior enrollment know-how, so they could troubleshoot difficult cases and learn from and support each other’s work.
  • Long history together of working together: The coalition reflects decades of collaborative work on health care including creation of the first rural health centers and Community Care of North Carolina (CCNC), a Medicaid managed care program based on local collaboration that has reduced Medicaid spending growth.

The most impressive aspect of coordination was their statewide assister scheduling line. Legal Aid of North Carolina spearheaded this scheduling line with the help of the North Carolina Community Health Centers Association and input from the Navigator Consortium. Because the assisters were working in sync, consumers all across North Carolina could call one toll-free number and make an appointment for local in-person help with the enrollment process.

The hotline helped everyone involved. Consumers had an easier way to make appointments in their community that would fit their schedule. Assisters could identify which regions had greater demand for in-person help and send additional resources to those locations, and conversely spot areas where there were few appointments and work there on engaging more local partners and getting more consumers in the doors. For community and service organizations, the statewide phone line simplified handoffs to a single step where they could directly schedule an appointment with consumers looking for insurance.

In the end, all of this is important because we know that getting consumers to in-person assistance is critical to enrollment success — many consumers prefer applying in-person, and we have seen that it doubles the odds of a consumer getting covered.

For more ideas on how to take your outreach and enrollment efforts to the next level in the coming months, register today for our national conference, State of Enrollment: Getting America Covered, in Washington, D.C., June 16-18.

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